Summary
A number of theories have been devised to explain prostatic hypertrophy on an endocrine basis. None of these have been proved.
A number of endocrine preparations are in use in an attempt to replace surgery.
Such therapy is still in the experimental stage, and as in other experimental work, accurate controls are desirable.
A series of 93 cases of prostatic obstruction, treated by neither prostatectomy nor endocrines, is presented.
These cases had been followed over an average period of over four years.
A large number showed a sustained improvement after instrumentation alone.
This series may be regarded, (a) as a control series, (b) as a brief summary of the variability of the course of the disease without prostatectomy and as a reminder of the frequent apparent “cure” after minimal instrumentation.
Conclusions as to the efficacy of endocrine or other new methods of treatment are only valid if cases are followed up for a considerable period of time.
The period suggested is five years.
1. The anemia of civilian trauma (mainly limb injuries) has been studied in 57 patients.
2. In 22 patients the red cell volume, after primary blood loss has probably ceased, has been compared with the follow-up "normal" red cell volume. The red cell volume credit or deficit is taken as an index of the balance between primary blood loss and blood transfused, and was found to be the major factor contributing to the later polycythemia or anemia. The evidence suggests that an anemia of trauma due to unreplaced primary blood loss is still a common finding in civilian injuries today.
3. A further red cell volume estimate in 20 patients on the 4-14th day after injury showed on average a further fall of 11 per cent of the red cell volume. Evidence is presented for considering that there is a further disappearance of red cells after primary blood loss has ceased in all patients—even in those whose red cell volume did not fall.
4. The evidence suggests that the anemia of trauma is largely preventable by adequate blood transfusion in the majority of civilian injuries.
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